[Anxious-depressive disorders and metabolic syndrome]

Anxiety and depressive behavioural disorders often occur concomitantly and their incidence in the general population as well as in chronically ill is higher than anticipated. Pilsen study of male and female patients (N = 1,050) selected from a population-based sample of the primary prevention survey PILS III (Pilsen Longitudinal Study III) had proven an existence of associations between depressive behavioural disorder and metabolic syndrome (MS). Depressive disorders were nearly twice as frequent in patients with MS compared to individuals without MS (RR = 1.85; CI: 1.11-3.10). Patients with psychiatric disorders were excreting more cortisol in the urine than individuals without psychiatric disorders, while there was no difference in the excretion ofcatecholamines and serotonin. Our results provide an indirect evidence for the hypothesis suggesting that increased activation of the sympathoadrenal axis could be pathophysiologically involved in the concomitant occurrence of the typical MS risk factors and depressed mood. Anxiety and depressive disorders are linked to higher cardiometabolic risk, higher incidence of acute cardiovascular events as well as poorer prognosis for cardiac patients; they are comorbid to a range of other chronic internal diseases. The association between cardiovascular disease, diabetes and psychiatric disorders is bilateral, i.e. patients with anxiety and depression experience cardiovascular events more frequently, and the patients with type 2 diabetes and cardiometabolic diseases suffer more frequently from anxious-depressive disorder. In clinical practice, we should search for anxious-depressive disorders. At present, the patients with anxiety or depression should be considered in the primary disease prevention as patients at high risk of atherosclerotic vascular diseases as well as MS and type 2 diabetes. Treatment of these diseases as part of secondary prevention in patients with anxiety and depression must be more rigorous and intensive than in patients without these psychiatric disorders.